Contractor Start-Up Form
Installation Name:_____________________________________________ Installation Date:_____________________
Installation Address:_________________________________________________________________________________
Start-Up Company’s Name_______________________________________ Phone:____________________________
Name of Technician__________________________________________________________________________________
Appliance
(Below information can be obtained from appliance name plate)
Manufacturer:______________________________________________________________________________
Type (circle one): [
Boiler / Furnace / Other
] Model #:_______________ Serial #:____________________
Input MBH:_______________ Original Appliance Designed for (circle one): [
Oil / Natural Gas / Propane
]
Output MBH:______________
Limits
Limit Model No.
(Indicate n/a if not required by the appliance manuf.)
Operation Verified
Temperature
YES / NO
Pressure
YES / NO
LWCO
YES / NO
Other Limits
YES / NO / n/a
Burner
Fuel: [
Natural Gas / Propane
] Model #:________________ Serial #:_________________________
Combustion Head: ________ Propane Orifice Size(if installed):________ Air Shutter Setting:____________
Air Band Setting:____________
Chimney/Smoke Pipe
Chimney Type:[
Masonry / Metal Vent / Direct Vent
] Location (circle one): [
Inside / Outside
]
Chimney Height:_____________ Flue Pipe Size:______________ Flue Pipe Length:________________ Number
of Elbows:____________ Confirm Double Acting Draft Regulator Installed: [
Yes / No
]
Thermal Safety Switch Installed [
Yes / No
] Voltage: [
120V / 24V
]
Gas Supply Piping
Pipe Diameter:________ Length of Pipe from Burner to Meter:_________ Number of Elbows:__________
Gas Pressure to Burner Gas Valve While Burner is Operating ____________ Inches W.C.
Combustion Readings
O
2 :
_________% CO:__________ PPM CO
2 :
_________% Stack Temperature (325°F MIN.):__________°F
Manifold Gas Pressure:______(Inches W.C.) Draft at Breech_____W.C. Clocked Meter Input_________MBH
AFTER COMPLETION AFFIX TO APPLICATION
